Use of inhaled corticosteroids in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC).

Mar 24, 2025

Experts: Jennifer Pollock,Eva Polverino,Raja Dhar,Katerina Dimakou,Letizia Traversi,Apostolos Bossios,Charles Haworth,Michael R Loebinger,Anthony De Soyza,Montserrat Vendrell,Pierre Regis Burgel,Pontus Mertsch,Melissa Jane McDonnell,Sabina Skgrat,Luis Maiz-Carro,Oriol Sibila,Menno van der Eerden,Paula Kauppi,Adam T Hill,Robert Wilson,Branislava Milenkovic,Rosario Menéndez,Marlene Murris,Megan L Crichton,Sermin Borecki,Dusanka Obradovic,Muhammed Irfan,Venera Eshenkulova,Adam Nowinski,Adelina Amorim,Antoni Torres,Natalie Lorent,Tobias Welte,Francesco Blasi,Eva Van Braeckel,Josje Altenburg,Michal Shteinberg,Wim Boersma,Joseph Stuart Elborn,Stefano Aliberti,Felix C Ringshausen,Pieter Goeminne,James D Chalmers

Current bronchiectasis guidelines advise against the use of inhaled corticosteroids (ICS) except in patients with associated asthma, allergic bronchopulmonary aspergillosis (ABPA) and/or chronic obstructive pulmonary disease (COPD). This study aimed to describe the use of ICS in patients with bronchiectasis across Europe.
Patients with bronchiectasis were enrolled into the European Bronchiectasis Registry from 2015 to 2022. Patients were grouped into ICS users and non-users at baseline and clinical characteristics associated with ICS use were investigated. Patients were followed up for clinical outcomes of exacerbation, hospitalisation and mortality for up to 5 years. We evaluated if elevated blood eosinophil counts (above the laboratory upper limit of normal) modified the effect of ICS on exacerbations.
19 324 patients were included for analysis and 10 109 (52.3%) were recorded as being prescribed ICS at baseline. After exclusion of patients with a history of asthma, COPD and/or ABPA, 3174/9715 (32.7%) patients with bronchiectasis were prescribed ICS. Frequency of ICS use varied across countries, ranging from 17% to 85% of included patients. ICS users had more severe disease, with significantly worse lung function, higher Bronchiectasis Severity Index scores and more frequent exacerbations at baseline (p<0.0001). Overall, ICS users did not have a reduced risk of exacerbation or hospitalisation during follow-up, but a significant reduction in exacerbation frequency was observed in the subgroup of ICS users with elevated blood eosinophil counts (relative risk 0.70, 95% CI 0.59 to 0.84, p<0.001).
ICS use is common in bronchiectasis, including in those not currently recommended ICS according to bronchiectasis guidelines. ICS use may be associated with reduced exacerbation frequency in patients with elevated blood eosinophils.

© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

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ABOUT THE EXPERTS

Jennifer Pollock,Eva Polverino,Raja Dhar,Katerina Dimakou,Letizia Traversi,Apostolos Bossios,Charles Haworth,Michael R Loebinger,Anthony De Soyza,Montserrat Vendrell,Pierre Regis Burgel,Pontus Mertsch,Melissa Jane McDonnell,Sabina Skgrat,Luis Maiz-Carro,Oriol Sibila,Menno van der Eerden,Paula Kauppi,Adam T Hill,Robert Wilson,Branislava Milenkovic,Rosario Menéndez,Marlene Murris,Megan L Crichton,Sermin Borecki,Dusanka Obradovic,Muhammed Irfan,Venera Eshenkulova,Adam Nowinski,Adelina Amorim,Antoni Torres,Natalie Lorent,Tobias Welte,Francesco Blasi,Eva Van Braeckel,Josje Altenburg,Michal Shteinberg,Wim Boersma,Joseph Stuart Elborn,Stefano Aliberti,Felix C Ringshausen,Pieter Goeminne,James D Chalmers

Jennifer Pollock

Division of Respiratory Medicine and Gastroenterology, University of Dundee, Dundee, UK.

Eva Polverino

Pneumology Department, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain.

Hospital Universitari Vall d’Hebron, Barcelona, Spain.

Raja Dhar

C K Birla Hospital, Kolkata, India.

Katerina Dimakou

5th Pulmonary Department, “Sotiria” Chest Hospital, Athens, Greece.

Letizia Traversi

Pneumology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain.

Apostolos Bossios

Karolinska University Hospital, Stockholm, Sweden.

Charles Haworth

Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK.

Michael R Loebinger

Host Defence Unit, Division of Respiratory Medicine, Royal Brompton Hospital, London, UK.

Imperial College London, National Heart and Lung Institute, London, UK.

Anthony De Soyza

Lung Biology and Transplantation Group, University of Newcastle, Heaton, UK.

Montserrat Vendrell

University of Girona, Girona, Spain.

Pierre Regis Burgel

Hopital Cochin Pneumologie, Paris, France.

Pontus Mertsch

LMU Munich Faculty of Medicine, Munchen, Germany.

Melissa Jane McDonnell

Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.

Sabina Skgrat

Pulmonary Diseases and Allergy, University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia.

Luis Maiz-Carro

Pneumology, Hospital Universitario Ramon y Cajal, Madrid, Spain.

Oriol Sibila

University of Barcelona, Barcelona, Spain.

ISCIII, Madrid, Spain.

Menno van der Eerden

Pulmonary Diseases, Erasmus MC, Rotterdam, The Netherlands.

Paula Kauppi

Allergology, Skin and Allergy Hospital, Helsinki, Finland.

Adam T Hill

Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.

Robert Wilson

Royal Brompton Hospital, London, UK.

Branislava Milenkovic

Clinic for Pulmonary Diseases, Klinicki centar Srbije, Beograd, Serbia.

Rosario Menéndez

Pulmonology, Hospital Universitari i Politecnic La Fe, Valencia, Spain.

Marlene Murris

CHU Toulouse, Toulouse, France.

Megan L Crichton

School of Dentistry Public Health Team, University of Dundee, Dundee, UK.

Sermin Borecki

Department of Pulmonology Diseases, Istanbul University, Fatih, Turkey.

Dusanka Obradovic

Institute for Pulmonary Diseases, Sremska Kamenica, Serbia.

Muhammed Irfan

Aga Khan University, Karachi, Pakistan.

Venera Eshenkulova

National Centre for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.

Adam Nowinski

Department of Epidemiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.

Adelina Amorim

Serviço de Pneumologia, Centro Hospitalar São João, Porto, Portugal.

Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

Antoni Torres

UVIR, Hospital Clínic, Barcelona, Spain.

Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain.

Natalie Lorent

Universitaire Ziekenhuizen Leuven, Leuven, Belgium.

Tobias Welte

Respiratory Medicine, Medizinische Hochschule Hannover, Hannover, Germany.

Francesco Blasi

Dipartimento Toraco-Polmonare e Cardiovascola, University of Milan, Milan, Italy.

Eva Van Braeckel

Department of Internal Medicine and Pediatrics, Ghent University, Gent, Belgium.

Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.

Josje Altenburg

Department of Pulmonary Diseases, AMC, Amsterdam, The Netherlands.

Michal Shteinberg

Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel.

The B. Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.

Wim Boersma

Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands.

Joseph Stuart Elborn

Centre for Infection and Immunity, Queens University Belfast, Belfast, UK.

Stefano Aliberti

Department of Biomedical Sciences, Humanitas University, Sosnowiec, Poland.

Respiratory Unit, Rozzano, Italy.

Felix C Ringshausen

Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.

Pieter Goeminne

Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium.

James D Chalmers

Division of Respiratory Medicine and Gastroenterology, University of Dundee, Dundee, UK j.chalmers@dundee.ac.uk.